Metformin Induced Vitamin B12 deficiency: A Cross sectional study. Untangling the connection.

Background: Metformin is a widely popular drug to treat type 2 diabetes as it is efficacious, inexpensive and relatively well tolerated with minimal side effect profile. It is known that long term metformin use predisposes a person to develop Vitamin B12 deficiency, however guidelines to screen and...

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Publicado en:Clinical Medicine Insights: Endocrinology & Diabetes Vol. 18; pp. 1 - 9
Autores principales: Ballal, Arjun, Vidyasagar, Sudha, Acharya, Vasudev, Amrutha Sukumar, Cynthia
Formato: research tables/charts Journal Article
Publicado: Sage Publications Inc. 12/18/2025
Acceso en línea:Ver este registro en EBSCOhost
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      dt: 12/18/2025
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      pub: Sage Publications Inc.
      place: Thousand Oaks, California
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        atl: Metformin Induced Vitamin B12 deficiency: A Cross sectional study. Untangling the connection.
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        au:
          Ballal, Arjun
          Vidyasagar, Sudha
          Acharya, Vasudev
          Amrutha Sukumar, Cynthia
        affil: Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, India
      sug:
        subj:
          Drug Utilization
          Metformin Administration and Dosage
          Diabetes Mellitus, Type 2 Drug Therapy
          Vitamin B12 Deficiency Risk Factors
          Treatment Duration
          Diabetic Neuropathies Risk Factors
          Vitamin B12 Deficiency Etiology
          Anemia, Macrocytic Risk Factors
          Human
          Cross Sectional Studies
          Prospective Studies
          Nonexperimental Studies
          Tertiary Health Care
          Vitamin B12 Blood
          Vitamin B12 Deficiency Epidemiology
          Diabetic Patients
          India
          Adult
          Middle Age
          Aged
          Aged, 80 and Over
          Male
          Female
          Analysis of Variance
          Multivariate Analysis
          Descriptive Statistics
          Chi Square Test
          Anemia Risk Factors
          Questionnaires
          Diabetic Nephropathies Risk Factors
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Aged: 65+ years
          Aged, 80 & over
          Male
          Female
      ab: Background: Metformin is a widely popular drug to treat type 2 diabetes as it is efficacious, inexpensive and relatively well tolerated with minimal side effect profile. It is known that long term metformin use predisposes a person to develop Vitamin B12 deficiency, however guidelines to screen and treat are yet to be well established. Vitamin B12 deficiency is known to cause peripheral neuropathy and anemia. Methods: Ours is a prospective, observational, cross sectional study based in a hospital setting in a tertiary care center. Study participants were subjected to serum Vitamin B12 analysis and Michigan neuropathy screening instrument was used to screen for peripheral neuropathy. Results: We report statistically significant association between metformin use and development of Vitamin B12 deficiency. The average duration of metformin use that resulted in development of Vitamin B12 deficiency was 13.6 years. We also found statistically significant association of metformin use with development of peripheral neuropathy. Conclusion: Long term metformin leading to Vitamin B12 deficiency is common knowledge, however we need more targeted guidelines on when to screen and treat for B12 deficiency. Some subsets of the population such as elderly and vegetarians are more prone and hence we need to educate more physicians and patients on the same. Plain language summary: Metformin Induced Vitamin B12 deficiency Diabetes is a hugely prevalent disease resulting from a persistently elevated blood glucose level. It adverse effects on overall lifespan and lifestyle are well known. Long standing diabetes is so dangerous as it affects blood vessels of different calibers which eventually leads to injury of the organs it supplies. Diabetic peripheral neuropathy is a term used when there is injury to nerves supplying the limbs because of long standing and often uncontrolled diabetes. A similar neuropathy/nerve damage may result from other causes such as Vitamin B12 deficiency. A popular drug used to control blood sugars is Metformin. It is considered effective and relatively safe and cost effective, making it a popular choice to treat Type 2 diabetes. Metformin has been known to contribute towards Vitamin B12 deficiency in a small sub group of users when used for a long duration. In this prospective observational study our intent primarily was to explore this association. Results from our study show that there is a direct association between the dose and duration of metformin use with the development of Vitamin B12 deficiency. This would mean that a person on long term metformin is more likely to develop Vitamin B12 deficiency as an undesired effect. This is in line with other Indian and International studies which have showed similar results as ours. Although our study also showed an increased likelihood of neuropathy with metformin use, the results were not statistically significant to make an association. New guidelines have since been set forth by the American diabetic association to screen for Vitamin b12 deficiency among people with diabetes on metformin. As this is a easily preventable side effect, when screened and treated, it is important to create awareness among both physicians and people with diabetes regarding this association.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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